New Diagnosis: Kitty

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I'd consider that flat really, factoring in meter variance (up to 20%).

It's possible her body is getting more "used" to the insulin, but honestly sometimes odd things just happen. It's complex biology after all!

But now an important note - I would only shoot the full dose over 250 (coincidentally that's also what dosing sticky says). Reason being - you can tell from the last few days that she would likely end up right around 90 at nadir if you shot full dose at 250. We do not want her any lower than that. We try not to skip as that throws things out of whack, so I would say in the 200-249 range try 2U if you're around to monitor... otherwise do something like 1U. I would skip anything under 200 for the time being
 
Hi,

Just wanted to check in. I found a small amount of puke this morning. It was just 15 pieces of undigested dry food and what I'm assuming is water. It was on the couch, so it got absorbed so its hard to tell how much liquid it was but there was a wet spot surrounding the food. It happened at some point while I was sleeping but it was still wet so I assume it was sometime early this morning. I fed her as I normally do this morning and she ate up all of her FF pate with no issues. I have two cats so I don't really know which one it was, it was on the couch that she normally lays on, but the other cat does occasionally lay there too. If I assume it was Kitty, is this something I should worry about?

I'm back to work today, so I wont be around to check on her until about +5.

Also, her BG dropped from 347 to 297 an hour ago when I fed her, to now when its time for shot. I hate when it does this. Why does it go down when it should be staying around the same? It makes me nervous giving her shot.
 
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Technically within meter variance.

Sounds like a "scarf and barf". As a one time thing, not worrisome in terms of health. The only thing it impacts is shot, need to make sure she eats a decent amount before the shot. You didn't mention specific times so I'm not sure if/how it relates to shot.

If it was that hour before shot try to get her to eat a bit now just in case it was her
 
FrostD said:
Technically within meter variance.

Sounds like a "scarf and barf". As a one time thing, not worrisome in terms of health. The only thing it impacts is shot, need to make sure she eats a decent amount before the shot. You didn't mention specific times so I'm not sure if/how it relates to shot.

If it was that hour before shot try to get her to eat a bit now just in case it was her
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Sorry, I should have been more clear.

It happened sometime between +5 and +11 of yesterdays PM cycle, so it was late last night while I was sleeping. It wasn’t anything to do with this morning’s feeding.
 
FrostD said:
When do you next plan to scale back on the dry food?
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How much would be a good amount to scale back at this point? Should both AM and PM feeding be exactly the same? Is it too big of a jump to just remove the 1/4+ cup of dry and give an extra can of wet? If that's too big, maybe 1/8 cup dry and another 1/2 can of wet? I just worry because if I start this change tomorrow morning, I have to leave for work and wont be back to check on her until around +5. And you mentioned scaling back the Novolin in order to do the food transition?
 
Corey & Kitty said:
How much would be a good amount to scale back at this point? Should both AM and PM feeding be exactly the same? Is it too big of a jump to just remove the 1/4+ cup of dry and give an extra can of wet? If that's too big, maybe 1/8 cup dry and another 1/2 can of wet? I just worry because if I start this change tomorrow morning, I have to leave for work and wont be back to check on her until around +5. And you mentioned scaling back the Novolin in order to do the food transition?
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Well, the "proper" way would be more like the 1/8 cup dry you mentioned, then a few days later gone completely.

Now if it were me, I'd just go cold turkey and see if she'll go for it...

Yes to reducing Novolin dose - removing the very high carb dry food will lower BG on its own, we just don't know how much (it's pretty unpredictable for every cat). What's your schedule look like Thursday and Friday?

Does she eat the dry at a certain time (in terms of +3, +5, etc) or does she graze?
 
FrostD said:
Well, the "proper" way would be more like the 1/8 cup dry you mentioned, then a few days later gone completely.

Now if it were me, I'd just go cold turkey and see if she'll go for it...

Yes to reducing Novolin dose - removing the very high carb dry food will lower BG on its own, we just don't know how much (it's pretty unpredictable for every cat). What's your schedule look like Thursday and Friday?

Does she eat the dry at a certain time (in terms of +3, +5, etc) or does she graze?
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My schedule is about the same for the rest of the week, no days off until Sunday - Monday.

So I put down the canned and dry food at the same time for each feeding. She eats the canned food immediately and usually finishes most of it within 10-15 minutes, and its definitely all gone within the first 30-60 minutes. She's usually good for a while after that and doesn't touch the dry food until a little bit later and just grazes on it for several hours. I come home for lunch for an hour usually somewhere around +5 to +7 and there might be a little dry left but never very much, that's why sometimes I give her a little more than 1/4 cup because I don't like her being without food from +5 to +7 onward. Occasionally she will still have a small amount of dry food left around the +10 mark, but its never very much.
 
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Okie dokie. I changed my mind. Knowing this, I think the dry is what is keeping her afloat midcycle and muting the nasty drops we usually see on Novolin.

So my official, final recommendation at this point is to switch to Lantus whenever is convenient, starting with SLGS. You'll hold the starting dose for a week unless a reduction is earned, then at that point I'd change food next weekend assuming you're home.

The blood ketone meter will be a perfect warning system for you, lots of us use it. @Hendrick's mom and dad is a perfect example. Anecdotally the baseline for most cats seems to be around 0.4-0.8. When it starts creeping above that we increase food and fluids to help flush them out. Once.yoibget around 1.5 or higher we really start to raise an eyebrow and stay on top of it. There are two papers in the DKA post (linked in your main forum post) that say :
  • Study 1: blood ketone reading of 2.55mmol/L or higher is 94% accurate in diagnosing DKA, and values below that are 68% accurate at ruling out DKA
  • Study 2: blood ketone reading of 2.4mmol/L or higher is 100% accurate in diagnosing DKA, and values below that are 87% accurate at ruling it out
  • @Suzanne & Darcy going to tag you since I finally re-read them, and I know Darcy got much higher without going into DKA.
 
FrostD said:
Anecdotally the baseline for most cats seems to be around 0.4-0.8.
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I'm not sure if the vet checked her urine for ketones when she was initially diagnosed, if he did it must have been negative because he didn't mention anything about it. I know he checked the urine for glucose though. I have no reason to believe she has ketones. I've checked her urine once and it was negative on my test. I just thought that part of the formula for DKA is not enough insulin, so I get nervous since I'm going to be changing the insulin. Are ketones something I should be worrying about? Are you saying that in the 0.4-0.8 range is okay? How often should I check for ketones?
 
They usually don't check blood ketones unless they're hospitalized for suspected DKA, it's usually just a urine dipstick for regular labs.

When unregulated we do recommend testing daily for ketone-prone cats, maybe twice a week for others. When regulated, once a week. I know the strips are expensive, but I would baseline get 3 straight days of readings (just once a day) and base future testing frequency on what happens those few days.

My cat has never been above 0.6 unless he was sick, and even then I don't think he went above 1.2. I would say LO-0.6 is a good range. And he was very much unregulated for a long time. On the flip side, we've had cats that are mostly regulated that just jump all over with ketones. For whatever reason some cats are just prone to them.

I wouldn't worry much. DKA is not enough insulin + inappetence + underlying stress/infection. As long as she's eating, good. Stay on top of any signs of illness. Ketones are still a decent risk at the dose/insulin you're on now, I don't view Lantus as any more risky. In fact, it should let you get her better regulated and lower risk long term.

We're usually pretty good at determining a Lantus starting dose that nearly mimics the prior insulin...Novolin probably the trickiest one, but it should end up close. And if ketones do start rising, we'd potentially look at increases that are "outside the rules"
 
FrostD said:
When unregulated we do recommend testing daily for ketone-prone cats, maybe twice a week for others.
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When you say “ketone-prone” do you mean cats that have presented with ketones in the past?

On a slightly different topic, but still relevant if I have to start blood testing for ketones. I’ve noticed today that I’ve struggled getting her ears to bleed. They were bleeding so well and today it’s been difficult. I noticed on one ear she has a small bump when I rub the area I usually test from. I try to vary the spots that I use but maybe I am getting too close to the same spot each time? I hope I’m not harming her.
 
Corey & Kitty said:
When you say “ketone-prone” do you mean cats that have presented with ketones in the past?

On a slightly different topic, but still relevant if I have to start blood testing for ketones. I’ve noticed today that I’ve struggled getting her ears to bleed. They were bleeding so well and today it’s been difficult. I noticed on one ear she has a small bump when I rub the area I usually test from. I try to vary the spots that I use but maybe I am getting too close to the same spot each time? I hope I’m not harming her.
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Ketone prone is just cats that keep coming up with ketones. If she didn't have any at diagnosis, and your one test so far was good, it's probably ok (but no guarantees). I tagged Kyle (Hendrick's dad), if he gets a chance to pop in you can see he tracks it on his SS, he was randomly jumping around with ketones for awhile. If I recall correctly, Hendrick was diagnosed by being hospitalized with DKA to begin with.

I wish I knew why some days they bleed better than others, it seems to related to activity level a bit (I have a harder time when they've been sleeping vs up and about). Bump is possibly something like a blood blister? Not oozing like it's infected or anything right? Maybe just an odd poke and got a little swollen. I do try to rotate ears and test spots. So first test will be left ear halfway up, #2 right ear halfway up, #3 back to left ear but maybe 2/3 the way up, so on and so forth. I don't think you're harming her...early days can be a bit rough, but it should be smooth sailing pretty soon as her ears form more capillaries.
 
We try to cap threads at 50 posts just for ease of readability, if you need anything tomorrow can you start a new post please?
 
Yeah Hendrick spent 2 nights in the hospital with DKA so I was testing ketones every day after he was discharged. But these days we test every couple weeks.

Re: those poor ears -- we also do like @FrostD , move around the ear, from ear to ear, but also from side to side on each ear. The side with more hair is more difficult and i use more vaseline but at least it gives the other side a rest.

I noticed that some of the stuff linked on this site says to use the marginal vein but I have avoided that, pretty sure @Diane Tyler's Mom said try not to hit that, it causes bruising and such.
 
FrostD said:
We try to cap threads at 50 posts just for ease of readability, if you need anything tomorrow can you start a new post please?
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50 seems very low to me. I get not having threads with hundreds of replies and pages of stuff but a thread can hit 50 very quickly

just my .02 :rolleyes:
 
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